A lump in the neck | Prof. Dr. Alper Tunga Derin

What is a neck lump?

Any swelling that can be felt or seen in the neck is generally called a neck mass or neck lump. The neck contains many lymph nodes, the thyroid gland, the salivary glands, muscles, blood vessels and nerves, and a lump can arise from any of these structures.

Lymph nodes are part of the body's defence system. They can enlarge and become tender during a cold, tonsillitis or a dental infection, and they usually shrink over a few weeks as the infection settles.

In adults the picture is different: a neck lump that appears without an obvious infection and does not go away can be the first sign of a cancer of the mouth, throat, voice box, thyroid or skin, or of lymphoma. For this reason, guidelines recommend that a persistent neck mass in an adult be assessed systematically by a specialist.

Possible causes

Infection: reactive lymph node enlargement due to throat, ear, dental or skin infections is the most common cause; occasionally a node becomes infected and forms an abscess.
Thyroid disease: thyroid nodules and goitre may be noticed as a swelling at the front of the neck that moves when swallowing.
Salivary gland disease: stones, inflammation or tumours in the parotid gland in front of the ear or the submandibular gland under the jaw can cause a lump.
Congenital cysts: cysts such as thyroglossal duct cysts and branchial cleft cysts usually become noticeable in childhood or young adulthood, sometimes after an infection.
Skin and fatty-tissue lumps: lipomas and skin cysts are usually soft, slow-growing and benign.
Lymphoma: lymphoma, a cancer of the lymphatic system, can present with painless, enlarging lymph nodes, sometimes together with fever, night sweats and weight loss.
Cancer spreading to a lymph node (metastasis): cancers of the mouth, tonsil, base of tongue, voice box, thyroid or skin can spread to the neck lymph nodes. In HPV-related oropharyngeal cancer in particular, a painless and sometimes cystic neck lump may be the first sign; for this reason a lump that looks cystic is not assumed to be benign until the diagnosis is clear.

Neck lumps in children

In children, most neck lumps are reactive lymph nodes caused by infections and shrink on their own; soft, mobile nodes smaller than 1 cm are generally considered normal. A node may remain palpable for weeks. However, a child should always be seen by a doctor if the lump is hard, fixed, growing quickly, located above the collarbone, or accompanied by prolonged fever, night sweats or weight loss.

When to see a doctor

Urgent / emergency situations

If you have difficulty breathing or noisy, harsh breathing, call 112 or go to the nearest emergency department.
If you cannot even swallow your saliva or have marked difficulty opening your mouth, you need emergency assessment.
A rapidly enlarging, red, hot and painful neck swelling with high fever may be an abscess and should be assessed the same day.

Situations needing an appointment within days to weeks

In an adult, a neck lump that cannot be explained by an obvious infection and has lasted longer than about 2 weeks, or whose duration is unknown.
A lump that is firm, fixed to surrounding tissues (cannot be moved), larger than 1.5 cm, or has broken skin over it.
A lump accompanied by hoarseness, difficulty swallowing, ear pain on the same side, a persistent sore throat, a mouth ulcer that does not heal, nasal blockage or nosebleeds.
Unexplained weight loss, night sweats or prolonged fever.
Risk factors such as smoking or heavy alcohol use, being over 40, or previous treatment for head and neck cancer.
A swelling that keeps growing or lies just above the collarbone.

These signs do not mean that the lump is cancer; they only show that it should be assessed without delay. A definite diagnosis and treatment decision are made after examination and the necessary tests.

What happens at the appointment and which tests are done?

The assessment starts with a detailed history: how long the lump has been present, whether it is growing, pain, fever, voice and swallowing complaints, smoking and alcohol use, and past illnesses are asked about. The neck, the inside of the mouth, the tonsils and the skin are then carefully examined.

Endoscopic examination: a thin, flexible camera passed through the nose (flexible endoscopy) is used to inspect the base of the tongue, the throat and the voice box within a few minutes, usually after a local anaesthetic spray.
Ultrasound: a radiation-free scan that shows the structure and size of the lump and which tissue it comes from.
Fine-needle aspiration (FNA): a cell sample is taken from the lump with a thin needle, usually under ultrasound guidance. For lumps with an increased risk of cancer and an uncertain diagnosis, guidelines recommend FNA rather than open (surgical) biopsy as the first step, because an open biopsy can complicate later treatment if the lump turns out to be cancer.
Contrast-enhanced neck CT or MRI: recommended by guidelines for patients considered to be at increased risk of cancer, to show the extent of the lump and its possible source.
Additional tests: blood tests, thyroid tests or, in selected patients, PET-CT may be requested if needed. If these steps do not establish a diagnosis, a detailed examination of the mouth, throat and voice box under general anaesthesia may be recommended before any open biopsy.

Are antibiotics always needed?

No. Guidelines recommend that antibiotics should not be given routinely for a neck lump unless there are signs of bacterial infection (such as fever, redness, tenderness or a recent throat or dental infection). Even when antibiotics are given, a follow-up visit should confirm that the lump has really disappeared; a lump that shrinks after antibiotics may still need further assessment.

Treatment

Treatment depends entirely on the cause of the lump. Lymph nodes caused by infection often settle without treatment or with treatment of the underlying infection; if an abscess develops, drainage may be needed. For thyroid nodules, salivary gland lumps and congenital cysts, observation, medication or surgery are considered according to the features of the condition.

If the lump turns out to be due to cancer, the treatment plan is usually decided by a multidisciplinary tumour board according to the type, site and extent of the cancer, and may include surgery, radiotherapy and drug treatments.

Self-care and follow-up

Note when you first noticed the lump, its size and any accompanying complaints; this information is very helpful at the appointment.
Avoid repeatedly squeezing or rubbing the lump, and never try to puncture it yourself.
If your doctor recommends observation, find out which changes (growth, hardening, new complaints) should prompt an earlier visit, and do not miss the follow-up appointment.
Stopping smoking and alcohol is among the most effective ways to reduce the risk of head and neck cancer.

Frequently asked questions

Being painless is not reassuring on its own. Lymph nodes caused by infection are often tender, whereas lumps due to cancer or lymphoma are frequently painless. In an adult, a painless lump lasting longer than a few weeks should be assessed.

Fine-needle aspiration is a safe, minimally invasive method recommended by guidelines for neck lumps; spread of tumour along the needle track has been reported only very rarely, which is why it is preferred over open surgical biopsy as the first step.

Yes. It is recommended that a follow-up examination confirms the lump has completely disappeared. A lump that shrinks but does not fully go away, or that grows again, needs further assessment.

Small, soft, mobile lymph nodes are very common in children and are usually linked to recent infections. Take your child to a doctor if a node is hard, fixed or growing quickly, if it sits above the collarbone, or if there is prolonged fever, night sweats or weight loss.

Smoking and alcohol are important risk factors, but they are not the only causes. HPV-related oropharyngeal cancer can occur in non-smokers and relatively young people, and its first sign may be a painless neck lump. That is why persistent lumps should be assessed regardless of risk factors.

Sources

The general information on this page is based on the guideline and institutional sources below. Individual diagnosis and treatment decisions require an examination.